A computer-assisted case audit and educational feedback system has been developed and pilot tested by the Yale Trauma Program. This system performs detailed, concurrent, case-by-case review and delivers audit reports to the physician within 48 hours of the patient encounter. The physician responds to the audit through written comments explaining his rationale for any deviations from audit criteria. The purpose of the proposed study is to determine the feasibility, acceptability, and effectiveness in various emergency department settings of the above educational feedback system. The system will be judged feasible if hospital administrations are willing to incorporate the system into existing institutional structures and procedures. It will be judged acceptable if physicians prove able and willing to provide the data required for detailed patient care review. The system will be judged effective if it leads to modification of physician practices in the direction of improved patient care. A 12-month randomized controlled trial of the feedback system in the Yale-New Haven Hospital Emergency Service demonstrated its feasibility, acceptability, and effectiveness in this setting. The system was used to monitor the decision-making and clinical performance of a group of surgical house officers caring for patients with soft tissue injuries in this university medical center. While this initial experiment demonstrated conlusively tht the system has great potential for medical education and quality assurance, the experimental results are based on the experience of a single institution. During the proposed project period, an expanded feedback system including lacerations, burns, soft tissue infections, and upper and lower extremity injuries, will be tested in six additional hospital emergency departments in order to discover whether the positive results obtained at Yale are reproducible elsewhere.